Central African Republic: Measles Outbreak - Jan 2020

Disaster description

On 24 January, the Ministry of Health declared a national epidemic of measles. More than 3,600 cases were registered and 53 persons have died so far between February 2019 and January 2020. Several cases are reported in northern and central provincial towns such as Paoua, Vakaga, Nana-Gribizi, Batangafo, Bocaranga, Ngaoundaye and Bambari. The authorities are calling for support from technical partners and donors to scale up the response against the outbreak to immediately secure sufficient quantities of vaccines, targeting all children aged between 6 months and nine years old. (OCHA, 29 Jan 2020)

The measles outbreak in Central African Republic, formally declared by the Ministry of Health on 24 January 2020, is evolving rapidly in numbers and expanding geographically. The incidence cases have risen sharply in the last weeks, following weeks of a gradual decline in the weekly trend in December 2019. In week 6 (week ending 9 February 2020), a total of 82 suspected measles cases and no deaths were reported, compared to 195 cases and one death in week 5 and 483 cases and no deaths in week 4. Between weeks 1-6 of 2020, a total of 1 498 suspected measles cases, including 15 deaths (case fatality ratio 0.3 %) have been reported in 13 out of the 35 districts in the country. Of the 13 districts with active measles outbreaks, five have been newly affected in 2020, namely Bangui in an urban area, Baboua-Abba, Nangha-Boguila, Bossémbélé, and Ouango-Gambo in rural areas. The last two districts around Bangui 1 (Bangui II and Bangui III) in urban areas and Bouar, Bozoum in rural areas reported suspected measles cases. Laboratory tests are ongoing. The measles outbreak in Central African Republic has been ongoing since early 2019 (week 5 of 2019) and continued through to 2020. There was an upsurge in cases in the last half of 2019, with a steady decline in December 2019. From 1 January 2019 to 9 February 2020, a total of 5 724 suspected measles cases, including 83 deaths (case fatality ratio 1.45%) have been reported in 13 health districts (WHO, 16 Feb 2020)

Between weeks 1-9, 2020, a total of 6641 suspected measles cases were reported in 21 of the 35 districts in the country. Of these, 517 cases were confirmed positive for measles immunoglobulin (IgM+) at the Institut Pasteur of Bangui. The majority (72%) of affected people are in the age group of 0 to 4 years, followed by the age group 5 to 10 years (18%). Females represent 49% of affected people. Since the beginning of the measles outbreak in early 2019 (week 5 of 2019) till week 9, 2020, a total of 11 496 suspected cases and 108 deaths (case fatality ratio 0.9%) have been recorded from 21 districts across the country. (WHO, 15 Mar 2020)

The measles outbreak in Central Africa Republic, first declared on 24 January 2020, shows a declining trend. In week 17 (week ending 25 April 2020), there were 274 new cases reported, with no deaths, compared to 649 cases (and 1 death) reported in week 16. From weeks 1 to 17 of 2020, there has been a total of 19 676 cases, with 86 deaths (case fatality ratio 0.43%). A total of 21 health districts have attained epidemic phase in 2020. During week 17, test results of 599 laboratory samples were released, of which 311 were positive for measles IgM, with 63 positive for rubella IgM.(WHO, 10 May 2020)

Since the beginning of 2020, the Central African Republic (CAR) has been facing a resurging measles epidemic. From 1 January to 22 September, 28,633 cases were reported, including 137 deaths, compared to 3,388 cases registered in 2019 and 241 in 2018. The epidemic has affected more than half of the country's 35 health districts with a high prevalence in the capital Bangui, the west and the centre-east. (OCHA, 14 Oct 2020)

On 24 January 2020, the Ministry of Health and Population declared a national measles epidemic. Subsequently, a response plan and a resource mobilization strategy were developed with the support of the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and non-governmental organizations. The main action adopted in the response plan consisted of a national vaccination campaign targeting 2.65 million children aged between 6 months and 10 years, with an emphasis on the children aged 6 months up to 5 years, given their particular vulnerability. Due to the limited availability of vaccines and medical equipment, a difficulty which was further amplified by COVID-19, the vaccination campaign was planned in two phases: a first phase in February and March covered the 13 most affected health districts and a second phase followed in August in the remaining 22 health districts. After an initial phase between January and March, where measles cases continued to increase, a decrease was observed in the 13 health districts that had already implemented the immunization campaign. In September, a considerable drop in suspected cases was noted with less than 50 new infections per week in the last two weeks of the month. (OCHA, 8 Dec 2020)

As of March 2021, three out of 35 health districts were affected by active measles outbreaks. In the first ten weeks of 2021 alone, 371 new suspected cases, including three deaths, were reported across the seven health districts. (OCHA, 22 March 2021)

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